Patel Jay, Bhaskar Sonu M M
Global Health Neurology Laboratory, Sydney, NSW 2150, Australia.
UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2170, Australia.
Pathophysiology. 2024 Jun 30;31(3):331-349. doi: 10.3390/pathophysiology31030024.
Atrial fibrillation (AF) significantly contributes to acute ischemic stroke, with undetected AF being a common culprit in cryptogenic strokes. N-terminal pro-B-type natriuretic peptide (NT-proBNP), indicative of myocardial stress, has been proposed as a biomarker for AF detection, aiding in the selection of patients for extended cardiac monitoring. However, the diagnostic accuracy of NT-proBNP remains uncertain.
We conducted a meta-analysis to evaluate the diagnostic accuracy of NT-proBNP in detecting AF among cryptogenic stroke patients. A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases to identify relevant studies. Studies reporting NT-proBNP levels in stroke patients and data on the proportion of patients with AF above a specified cut-off were included. Meta-analyses were performed using the midas command in STATA.
Seven studies encompassing 2171 patients were included in the analysis, of which five studies contained cohorts with cryptogenic strokes. Among patients with cryptogenic stroke, NT-proBNP demonstrated a diagnostic accuracy of 80% (Area Under the Receiver Operating Curve 0.80 [95% CI 0.76-0.83]), with a sensitivity of 81% (95% CI 0.68-0.89) and a specificity of 68% (95% CI 0.60-0.75).
Our meta-analysis indicates that NT-proBNP exhibits a good-to-very-good diagnostic accuracy for detecting AF in patients with cryptogenic stroke. These findings suggest potential implications for utilizing NT-proBNP in guiding the selection of patients for prolonged cardiac monitoring, thereby aiding in the management of cryptogenic stroke cases.
心房颤动（AF）是急性缺血性卒中的重要病因，隐匿性AF是不明原因卒中的常见罪魁祸首。N末端B型利钠肽原（NT-proBNP）可反映心肌应激，已被提议作为AF检测的生物标志物，有助于选择需要延长心脏监测的患者。然而，NT-proBNP的诊断准确性仍不确定。
我们进行了一项荟萃分析，以评估NT-proBNP在不明原因卒中患者中检测AF的诊断准确性。通过全面检索PubMed、Embase和Cochrane数据库来识别相关研究。纳入报告卒中患者NT-proBNP水平以及AF患者比例高于特定临界值数据的研究。使用STATA中的midas命令进行荟萃分析。
分析纳入了7项研究，共2171例患者，其中5项研究包含不明原因卒中队列。在不明原因卒中患者中，NT-proBNP的诊断准确性为80%（受试者工作特征曲线下面积为0.80[95%CI 0.76-0.83]），敏感性为81%（95%CI 0.68-0.89），特异性为68%（95%CI 0.60-0.75）。
我们的荟萃分析表明，NT-proBNP在检测不明原因卒中患者的AF方面具有良好到非常好的诊断准确性。这些发现提示在指导选择需要延长心脏监测的患者方面利用NT-proBNP具有潜在意义，从而有助于不明原因卒中病例的管理。
